Objective To assess the treatment of fresh Monteggia fracture with a steel-wire loop for adults whose annular ligament needs repairing. Methods From May 2006 to March 2008, we treated 15 adult patients with fresh Monteggia fracture whose annular ligament needed repairing with a steel-wire loop. A retrospective study was performed for the 15 cases, including 9 males and 6 females. Their ages ranged from 19 to 46 years. According to the Bado classification system, there were 6 cases of type Ⅰ, 4 type Ⅱ, 5 type Ⅲ. The ulnar fractures were treated with open reduction and compression plate fixation. Next, radial head dislocations were reduced openly and the reduced heads were hitched to the proximal end of the ulna with a steel-wire loop of 0.8 mm in diameter around the radial neck. Last, the broken annular ligaments were repaired. The elbow functional trainings were carried out 48 hours after operation and the steel-wire was removed 3 weeks postoperatively. Results The patients were followed up for 8 to 11 months (mean,9. 5 months). The functional recovery evaluated by Broberg and Morrey evaluation system showed excellent results in 11 patients, good in 2, fair in 2 and poor in 0. The excellent to good rate was 86. 7%.Conclusion The steel-wire loop treatment is a good strategy for adults with fresh Monteggia fracture whose annular ligament needs repairing.

BACKGROUND:Surgery has become gold standard to treat fracture of acetabulum.The incidence of posterior column fracture of affected acetabulum is high.The appropriate treatment for posterior column fracture of acetabulum remains controversial.OBJECTIVE:To establish the model of posterior column fracture of acetabulum,and evaluate the stability of internal fixation with the plate and lag screw for the posterior column fracture of acetabulum.METHODS:A total of 20 preserved cadaveric semipelvic specimens were randomly divided into two groups.Models of isolated posterior column fracture of acetabulum were established.The models were fixed with plate or lag screw.Under vertical compression load,the horizontal displacements of the fracture site were measured and the shear rigidity of two fixation conditions was compared.RESULTS AND CONCLUSION:The horizontal displacements of the fracture site fixed with plate and lag screw were (1.64±0.17) mm and (1.70±0.20) mm.The shear rigidity fixed with plate and lag screw were (392.40±41.22) N/mm and (386.33±50.07) N/mm.The differences of both horizontal displacements and shear rigidity between the two groups were not significant (P>0.05).The fracture model provides an ideal tool for biomechanical evaluation of the stability of internal fixation for the posterior column fracture of acetabulum.There was no significant difference in the stability of internal fixation with the plate and lag screw for the posterior column fracture of acetabulum.

Objective To evaluate the stability of 4 different methods of plate internal fixation for simulated posterior column fracture of the acetabulum.MethodsTwenty preserved cadaveric semipelvic specimens were divided into 4 groups randomly.Models of isolated posterior column fractures of acetabulum were established and then fixed with 1 of following 4 methods of plate internal fixation:2 screws at the each end of plate(group A),3 screws at the each end of plate(group B),1 screw each side in the closest allowable hole to the fracture and 2 screws at the each end of plate(group C),and 4 screws on each side of the fracture(group D).Under vertical compression load of 3 times' body weight,the displacements of the fracture site were measured and the shear rigidity of different internal fixation methods were compared.ResultsThe displacements of the fracture site in Group A,B,C,and D were 4.68?0.35,2.80?0.25,2.12?0.11 and 1.58?0.17 mm respectively,with a decreasing trend from Group A to D.The shear rigidity of internal fixation methods in Group A,B,C,and D were 129.42?9.60,228.91?12.05,285.21?26.16 and 414.71?34.29 N/mm respectively,with an increasing trend from Group A to D.The differences of both displacements and shear rigidity between each 2 groups were significant(P

Objective To test the Footscan system for guiding the postoperative rehabilitation of calcaneus fractures.Methods Sixty patients with unilateral calcaneus fracture were divided randomly into a rehabilitation group and a control group.Patients in both groups began a routine of functional rehabilitation training 24 h after a reduction and fixation operation.The patients in the rehabilitation group received individualized rehabilitation protocols based on regular dynamic evaluation of their plantar pressure using the Footscan system.Those in the control group were administered routine rehabilitation training without the personal modifications.At the 2nd and 7th month postoperation,the dynamic plantar pressure of both groups was evaluated and the functioning of their feet Was scored.Results At the 2nd month post-operation,there was no significant difference between the two groups in terms of subtalar ioint range of motion,the lateral deviation of pressure center,the time of heel touch with the ground,the maximum pressure at the lateral aspect of the calcaneus and impulsive force during walking.The functional evaluation scores were also not significantly different.At the 7th month post-operation,all the indices in both groups had improved significantly over the 2nd month,bulthe improvement in the rehabilitation group Was greater(except the time of heel touch with the ground).Conclusion The Footscan system can be a valuable tool for evaluating patients with calcaneus fracture and serve as a reference for planning rehabilitation interventions for such patients.

Objective To explore the effect of topical application of sodium hyaluronate on preventing perivascular adhesion of the vein grafts in rabbits. Methods Thirty-six male New Zealand white rabbits, aged 5 months, were randomly and equally divided into 2 groups: groups A and B. Arterial defect model was established by cutting about 1cm artery from the middle part of the dissected left common carotid artery. A section about 3cm was cut from the right external jugular vein, and the harvested vein was inverted and anastomosed end-to-end to the artery defect. After the anastomosis, the adventitia and two anastomoses of the grafted veins in group A were coated locally with 0.2ml sodium hyaluronate. The grafted veins were obtained 1, 2 and 4 weeks after the operation, with the perivascular adhesion of the vein grafts being examined macroscopically before the resection. HE staining and Masson staining were preformed for histological changes of grafted vein wall and the perivascular adhesion of the vein grafts. At 2, 4 weeks postoperation, the perivascular adhesions of the vein grafts were graded by the grading criteria of adhesion in macroscopic evaluation and histological evaluation. Result At 1, 2 and 4 weeks postoperatively, the macroscopic and histological observation found that the perivascular adhesions in group A were looser than those in group B. The macroscopic grade and histological grade were lower in group A than in group B, there was a significant difference between the two groups at 2 and 4 weeks postoperation (P<0.05). Conclusion Topical application of sodium hyaluronate can reduce the perivascular adhesion and is an ideal treatment strategy for preventing perivascular adhesion of vein grafts.

Objective To explore the role of serum inflammatory factors in prediction of infection following internal fixation of closed fractures and its significance for surgical timing and infection prophylaxis.Methods A retrospective study was conducted of the 100 patients who had been treated by internal fixation for closed fracture from January 2014 through July 2016.They were 52 men and 48 women,aged from 24 to 76 years (average,45 years).There were 14 femoral fractures,19 tibial plateau fractures,25 patella fractures,8 pilon fractures,22 tibiofibular shaft fractures,and 12 calcaneal fractures.Of them,21 were inflicted by wound infection.The preoperative and postoperative infection indexes,CRP,ESR,PCT and leukocyte count,were recorded.Logistic regression analysis was conducted to test the correlation between the infection indexes and postoperative infection.The optimal cut-off value was determined by the receiver operating characteristic curve.Results CRP showed a significant correlation with postoperative infection while other indexes did not.The optimal cut-off value was 25 mg/L at one day before operation.Conclusions Preoperative determination of CRP may predict the risk of postoperative infection.CRP ＞ 25 mg/L at one day before operation may indicate the following day is not suitable for surgery and active infection prophylaxis should be conducted after surgery.

【Objective】 To investigate the correlation of monocytes and high-density lipoprotein cholesterol ratio(MHR) and albumin with the severity of coronary artery lesions in patients with unstable angina pectoris. 【Methods】 We enrolled 342 patients with unstable angina pectoris. According to the Gensini score of their coronary angiography results, they were divided into Gensini≤ 20 group, 2040 group. The differences in biochemical indicators between the groups were compared, and the correlation between the different indicators and the Gensini score was analyzed. According to the MHR quartile grouping, there were differences between the comparison groups. LDL-C was divided into subgroups and then subjected to multifactor Logistic regression analysis. 【Results】 MHR differed significantly among low, moderate and high grade lesions (P<0.05). Subgroup analysis showed that in low LDL-C group, Gensini score was positively correlated with MHR(P<0.05), while in high LDL-C group, Gensini score was negatively correlated with albumin(P<0.05). Multivariate Logistic regression analysis showed that the MHR level of patients with high Gensini score was 102.375 times higher than that of patients with low Gensini score(P<0.05). In the group with high LDL-C, the serum albumin level in the group with low Gensini score was 1.431 times that in the group with high Gensini score and 1.218 times that in the group with moderate Gensini score(all P<0.05). 【Conclusion】 In patients with unstable angina pectoris, especially when LDL-C levels are not high, both high MHR and low serum albumin are independent risk factors for the severity of coronary artery disease.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

BACKGROUNDCigarette smoke induced airway inflammation plays a role in pathogenesis of airway inflammation. Resolvin-D1 derived from omega-3 polyunsaturated fatty acids is an endogenous anti-inflammatory and proresolving lipid mediator. Resolvin-D1 ameliorated inflammatory responses in lung injury, asthma, peritonitis and atherosclerosis. We investigated whether resolvin-D1 suppressed the productions of chemokines and oxidative stress induced by cigarette smoke extract (CSE) in vitro and its possible mechanism.

METHODSWe examined the proinflammatory chemokine interleukin-8 and hydrogen peroxide (H2O2) productions induced by CSE in 16 human bronchial epithelial (16HBE) cells after resolvin-D1 treatment and their mechanisms. 16HBE cells were treated with resolvin-D1 at up to 10 nmol/L, for 30 minutes before CSE up to 16% (v/v) exposure. Release of interlukin-8 proteins was assessed by enzyme linked immunosort assay (ELISA) and its mRNA level by RT-PCR. We evaluated extracellular H2O2 expression in the supernatant. Phosphorylation of NF-κB/p65 and degradation of I-κB in 16HBE cells were determined by Western blotting analysis and NF-κB DNA binding activity by electrophoretic mobility shift assay (EMSA).

RESULTS16HBE cells treated with 8% CSE showed significantly higher interlukin-8 production. Resolvin-D1 pretreatment inhibited CSE induced interlukin-8 production (mRNA and protein) in a dose and time dependent manner. Extracellular H2O2 level decreased after resolvin-D1 treatment. Resolvin-D1 attenuated CSE triggered I-κB degradation and NF-κB/p65 activation dose dependently and inhibited NF-κB DNA binding activity.

CONCLUSIONResolvin-D1 inhibits CSE induced interlukin-8 and H2O2 production in 16HBE cells by modulating NF-κB activation and has therapeutic potential for pulmonary inflammation.

Blotting, Western ; Cell Line ; Cell Survival ; drug effects ; Docosahexaenoic Acids ; pharmacology ; Electrophoretic Mobility Shift Assay ; Enzyme-Linked Immunosorbent Assay ; Humans ; Hydrogen Peroxide ; metabolism ; Interleukin-8 ; metabolism ; NF-kappa B ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Smoking ; adverse effects

【Objective】 4-like protein with down-regulated expression and development in neural precursor cells (NEDD4L) plays an important role in blood pressure (BP) regulation and sodium homeostasis by regulating epithelial sodium channel protein. In this study, we aimed to explore the relationship of NEDD4L gene polymorphisms with BP responses to sodium and potassium intake. 【Methods】 In 2004, 514 subjects from 124 families in Meixian County, Shaanxi Province, were recruited to establish a salt-sensitive hypertension study cohort. All the subjects received a 3-day baseline survey, a 7-day low-salt diet, a 7-day high-salt diet, and finally a 7-day high-salt and potassium supplementation. Their BP was measured and peripheral blood samples were collected at different intervention periods. The 14 gene polymorphisms of NEDD4L gene were genotyped and analyzed by MassARRAY platform. 【Results】 BP decreased on a low-salt diet, and significantly increased on a high-salt diet, and decreased again after potassium supplementation. NEDD4L SNPs rs74408486 were significantly associated with systolic BP, diastolic BP and mean arterial pressure responses to the low-salt diet. SNPs rs292449 and rs2288775 were significantly associated with pulse pressure response to the high-salt diet. In addition, SNPs rs563283 and rs292449 were significantly associated with diastolic BP, mean arterial pressure, and pulse pressure responses to high-salt and potassium supplementation diet. 【Conclusion】 NEDD4L gene polymorphisms were significantly associated with BP responses to sodium and potassium intake, suggesting that NEDD4L gene may be involved in the development of salt sensitivity and potassium sensitivity.